| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,465 |
1,461 |
$106K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
947 |
943 |
$15K |
| V2750 |
Anti-reflective coating, per lens |
794 |
790 |
$8K |
| V2744 |
Tint, photochromatic, per lens |
60 |
60 |
$1K |
| V2020 |
Frames, purchases |
116 |
109 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
78 |
77 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$256.28 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
13 |
$156.76 |